Biceps Tendon Repair

The biceps is a muscle on the front part of the upper arm that is attached to bones in the shoulder and the elbow across the front by connective tissue (tendons).  The biceps muscle helps you bend the elbow and rotate your forearm (supination of the forearm) during activities like turning a door handle or tightening a screw with a screwdriver.

Causes of a Biceps Tendon Tear

The biceps tendon can tear at either end, and occasionally at the tendon – muscle belly junction.  Biceps tendons tears can be partial or complete. Partial tears damage the soft tissue but do not completely sever the tendon, whereas a complete tear will sever the tendon completely from the bone.

Tears or ruptures are commonly found in men above middle age; however, they can also occur in younger and elderly people and are usually a result of lifting or pulling a heavy object.

Proximal Biceps Tendon Tear at the Shoulder (Upper End – Long Head of the Biceps Tear)

A proximal biceps tendon rupture is the most common type of biceps tendon injury, found mostly in people over the age of 60, resulting in minimal symptoms.  This type of injury occurs when one of the tendons that attaches the bicep to the shoulder tears as a result of age related degeneration and fraying of the tendon, but may also occur as a result of an injury.

This injury usually results in only one part (the long head) of the tendon tearing, allowing one to continue to use one’s arm.  However, a biceps tendon tear or rupture at the shoulder can also be associated with damage to other tendons (Rotator Cuff) of the shoulder, which may need treating surgically.

Distal Biceps Tendonitis and Tear at the Elbow (Lower End – Distal Biceps Rupture)

A biceps tendon tear at the elbow is less common, typically as a result of wear and tear but can also occur due to repetitive movements, unusually heavy lifting, or sudden unexpected loading of the elbow.  This stress can cause the tendon to tear completely from the bone.  Surrounding forearm muscles will compensate so you will still have full mobility, but there may be some weakness of specific movements and function of the elbow, particularly supination.

Tendonitis

Tendonitis is an inflammation caused by overusing tendons and creating micro tears resulting in soreness and pain.  Similar to distal biceps tendonitis, tendonitis of the long head of the bicep is typically a result from wear and tear and repetitive movements.  You can develop biceps tendonitis in both the shoulder and the elbow, along with other problems such as arthritis or persistent shoulder dislocation.  It is uncommon to have tendonitis in the shoulder and the elbow at the same time.

Symptoms of a Biceps Tendon Tear

The most obvious symptoms of a torn or ruptured tendon is sudden pain in the affected area.  Pain is severe at first but will usually decrease after a couple of weeks. Other symptoms of a torn or ruptured tendon may include:

• Feeling or hearing a “pop” or tearing sensation
• Incapability to bend or straighten the elbow
• Visible bruising or swelling
• Weakness in the arm/forearm
• Cramping in the muscles
• Warmth around the affected area
• An ache or pain in the affected area and throughout your arm
• Increased pain in your arm following repetitive activity
• A bulge in the upper arm, due to recoiled or shortened biceps muscle – Cosmetic ‘Popeye’ deformity
• A gap or indentation in front of your elbow

In many cases, people with a torn tendon will still be able to function normally and retain near full use of their arm.

Diagnosis of a Biceps Tendon Tear

Making the diagnosis of a torn biceps tendon is usually straightforward; however, the same treatment may not work for everyone so deciding whether surgery is necessary is dependant on individual assessment and circumstances.  Your doctor will start by asking about your symptoms and whether there was an occurrence that caused the pain such as a recent injury.  You may then undergo a physical exam to determine your range of movement and strength in your arm.  The doctor will document if you experience pain with certain movements, specifically rotations and whether or not you are showing signs of bruising or swelling.

To rule out any bone injuries, your doctor may suggest undergoing imaging tests such as an X-ray or an MRI scan, to determine whether the tear is partial or complete, and also to rule out other associated injuries to surrounding tendons such as the rotator cuff of the shoulder.

Treatment of a Distal Biceps Tendon Tear

Non-Surgical Treatment

Surgery to reattach the tendon to the bone may be required to regain full arm strength and function.  For individuals who are older, and/ or less active, nonsurgical treatments may be the preferred option.  Nonsurgical treatments focus on relieving pain, and restoring and maintaining as much function as possible within the affected arm.  Rest, anaelgesia and nonsteroidal anti-inflammatory medications (NSAIDs), ice/heat packs, combined with physical therapy are all steps you can take to control the pain and strengthen muscles to return as much functionality as possible.  The cosmetic deformity however persists with non-surgical management. 

Torn Distal Biceps Tendon Repair Surgery

If nonsurgical treatment options fail to alleviate pain and restore function, your doctor may suggest surgery as an option for you to repair the tendon.  Surgery to re-attach the tendon to the bone should ideally be carried out as soon as possible, preferably within the first few weeks after the injury occurred.

New techniques have been developed that repair the tendon with limited incisions.  The goal of the surgery is to reattach the torn tendon back to the bone.  Your doctor will discuss the best options with you.

In most cases, doctors prefer to use one cut at the front of the elbow.  Occasionally, more than one incision is needed.  The tendon is then reattached to the forearm bone using special stiches and bone anchoring devices.  Modern fixation techniques usually allow immediate mobilisation, especially if the tendon is fixed early, with near full recovery of function within 12 weeks.

Allograft Reconstruction of the Distal Biceps – Late Presenting Cases

For patients who present late with significant ongoing symptoms, and a very shortened and scarred tendon, the surgeon may need to use an allograft tendon for repair. This is a donor tendon graft that is used to bridge the large gap that occurs at between the end of the shortened tendon and its original attachment site on the bone. The recovery following this procedure is 1 year post surgery.  The surgeon would discuss this in detail with you if it was felt necessary to adopt this procedure.

Recovery from Biceps Tendon Repair Surgery

Biceps tendon repair involves the cutting of skin, tendons, and bone, so you will require strong pain medication for 1–2 weeks during the recovery period.  Recovery time depends on the type of bicep tendon tear, as well as the type of surgical treatment you have undergone.  Most people make a rapid and full recovery after surgery, with excellent outcomes by 12-16 weeks.  Re-tear rates are extremely low.

A pain block may be used to numb the elbow for 12-18 hours’ post-surgery.  Wearing a sling for comfort and rest is advised to help the healing process.  You can take part in light activities soon after your surgery but heavy lifting and strenuous activities should be avoided for several weeks.  Physical therapy is advised after surgery to help rebuild strength and restore the range of motion.

Risks and Complications

As with any surgery, there is always the possibility of infection, bleeding or blood clots, and allergic reaction to the anaesthetic.  Complications following biceps tear repair surgery are uncommon but they can occur.  These include:

• Injury to the nerves around the elbow
• Stiffness of the elbow
• Heterotrophic ossification – this is the formation of abnormal and extra bone around the elbow following surgery.  It can cause stiffness of the elbow and forearm and may need further surgery
• Damage to nearby structures (muscle/ nerves/ blood vessels)
• Ongoing pain
• Re-tear
• Change in the arm’s appearance (if an injured tendon becomes detached, it can bunch up and form a bulge along the arm)

If you are worried about any reactions you are experiencing, contact your doctor as soon as possible.

Outlook after Biceps Tendon Repair

Bicep tendon tears can be serious, but in many cases can be treated with nonsurgical treatment, such as physical therapy and rest.  If you think you may have damaged your biceps tendon, visit a doctor immediately as getting a diagnosis and treatment as soon as possible will benefit your recovery.

At One Healthcare we can book you in to see a specialist Orthopaedic Shoulder Surgeon for an initial consultation, usually within 48 hours.  Biceps Tendon Repair surgery is available at One Ashford Hospital in Kent and One Hatfield Hospital in Hertfordshire. 

You can use your private medical insurance or pay for your Biceps Tendon Repair treatment. We offer competitive, fixed price packages. If you are using your health insurance, please contact your insurer first for approval and let them know you’d like to be treated at either the One Ashford Hospital or One Hatfield Hospital.

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